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Submit your referral to the Colorado Fetal Care Center at Health. This form covers maternal history and consultations for high-risk pregnancies, effective 2019.
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How to fill out maternal fetal referral form
01
Obtain the maternal fetal referral form from the healthcare provider or hospital.
02
Fill out the patient's personal information including name, date of birth, address, and contact number.
03
Provide information about the referring healthcare provider and their contact details.
04
Specify the reason for the referral and any relevant medical history or test results.
05
Include any special instructions or requests for the maternal fetal specialist.
06
Review the form for accuracy and completeness before submitting it to the appropriate healthcare facility.
Who needs maternal fetal referral form?
01
Pregnant women who require specialized care or monitoring for high-risk pregnancies or fetal abnormalities.
02
Healthcare providers who need to refer patients for maternal fetal medicine consultations or services.
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What is maternal fetal referral form?
The maternal fetal referral form is a document used by healthcare providers to refer patients who are pregnant and may require specialized care for maternal or fetal health issues.
Who is required to file maternal fetal referral form?
Healthcare providers, such as obstetricians, midwives, and primary care physicians, are typically required to file the maternal fetal referral form when referring a patient to a maternal-fetal medicine specialist.
How to fill out maternal fetal referral form?
To fill out the maternal fetal referral form, providers need to include patient identification information, details of the pregnancy, relevant medical history, specific concerns that warrant the referral, and the referring provider's information.
What is the purpose of maternal fetal referral form?
The purpose of the maternal fetal referral form is to ensure appropriate and timely care for patients with high-risk pregnancies by providing specialists with necessary patient information.
What information must be reported on maternal fetal referral form?
Information that must be reported includes the patient's name, date of birth, medical history, current health status, reason for referral, and other relevant clinical data.
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